Femoral Neck Fracture in a Pediatric Patient with Primary Hyperparathyroidism

Abstract

Case: A previously healthy 11-year-old girl underwent expedited surgical fixation of a femoral neck fracture sustained while jump-roping. After further work up, she was diagnosed with primary hyperparathyroidism. Parathyroidectomy of a hypertrophic adenoma proved curative. Now, five months post left hip surgery, the patient is pain-free and walks without a limp.

Conclusion: We describe the first published case of primary hyperparathyroidism presenting as a pathologic hip fracture in a child. Although presentation with a fracture is exceedingly rare, bone pain is a frequent complaint of pediatric hyperparathyroidism. Orthopedic surgeons may find themselves the front-line caregivers for the condition.

Figure 1

Initial X-rays demonstrating a Delbert type III left-sided femoral neck fracture.

Figure 2

Intraoperative fluoroscopy demonstrating closed reduction utilizing a traction table and placement of two 6.5 mm screws for fixation.

Figure 3

Mandibular X-rays on hospital day 2 displayed a lytic lesion with cortical breakthrough adjacent to the mandibular symphysis and a small area of erosion at the mandibular angle.

Figure 4

Hematoxylin and eosin stain at 100x magnification of the resected parathyroid gland demonstrating a well-circumscribed with mass with eosinophili cells that exhibit large atypical nuclei with prominent nucleoli.

Figure 5

Cyclin D1 staining of the resected parathyroid gland shows diffusely positive staining for cyclin D1.

Figure 6

X-rays taken at 5 months postop demonstrate healing of the femoral neck fracture in some varus with some shortening of the femoral neck.